The Child-Pugh score is a system for assessing the prognosis — including the required strength of treatment and necessity of liver transplant — of chronic liver disease, primarily cirrhosis. It provides a forecast of the increasing severity of your liver disease and your expected survival rate.
It’s also referred to as the Child-Pugh classification, the Child-Turcotte-Pugh (CTP) calculator, and the Child Criteria.
The Child-Pugh score is determined by scoring five clinical measures of liver disease and the possibility of eventual liver failure. A score of 1, 2, or 3 is given to each measure, with 3 being the most severe.
Child-Pugh score calculator
Determining the Child-Pugh score is basically like using a sort of calculator. There are five factors that you will select from, and once added up, it’ll determine your score.
The five clinical measures are:
- total bilirubin: yellow compound in bile from hemoglobin breakdown
- serum albumin: blood protein produced in the liver
- prothrombin time, prolongation(s) or INR: time for blood to clot
- ascites: fluid in peritoneal cavity
- hepatic encephalopathy: brain disorder from liver disease
- If the ascites result is “none,” that measure would be scored with 1 point.
- If the ascites result is “mild/diuretic responsive,” that measure would be scored with 2 points.
- If the ascites result is “moderate/diuretic refractory,” that measure would be scored with 3 points.
The interpretation of the clinical measures is as follows:
- 5 to 6 points
- least severe liver disease
- one- to five-year survival rate: 95 percent
- 7 to 9 points
- moderately severe liver disease
- one- to five-year survival rate: 75 percent
- 10 to 15 points
- most severe liver disease
- one- to five-year survival rate: 50 percent
By figuring out this score, you can determine the likely severity of your liver damage, and as a result predict your mortality rate. This can be a valuable tool in helping doctors decide whether you’re a good candidate for elective surgery, if necessary. Furthermore, learning about your score can help you to decide what long-term lifestyle changes may work to prevent your score from becoming more severe.
The Model for End-Stage Liver Disease, or MELD score, is used to prioritize adult patients for liver transplants. It’s a severity index that indicates mortality risk and case urgency. It determines how soon a person will need a liver transplant.
You must have a MELD score to be put on the United Network for Organ Sharing (UNOS) transplant list.
The MELD score is calculated with a mathematical formula using three lab results:
The 4 MELD levels are
- greater than or equal to 25 (gravely ill)
- 24 to 19
- 18 to 11
- less than or equal to 10 (less ill)
Patients with end-stage liver disease are tested on a continuing basis:
- greater than or equal to 25: lab reports every 7 days
- 24 to 19: lab reports every 30 days
- 18 to 11: lab reports every 90 days
- 10 or fewer (less ill): lab reports every year
As the MELD score increases, the patient moves up the transplant list.
While both the Child-Pugh score and MELD score examine the quality of your liver, and assess how severe disease is in the organ, there are significant differences between the two. The main difference is that the Child-Pugh score analyzes the severity of long-term liver disease, and puts you in classes based on the severity. This can help map out a treatment plan.
This is different than the MELD score, which determines whether the level of your liver disease calls for a transplant and affects your standing on a waiting list. Furthermore, your MELD score will be recalculated from time-to-time to see if your disease has worsened and if your place on the waiting list needs to be changed.
The PELD score (Pediatric End-stage Liver Disease) is a version of the MELD score for children under the age of 12. Like the MELD score, it’s used to prioritize patients for liver transplant.
Part of the diagnosis and treatment portion of liver disease is a Child-Pugh score for the prognosis of liver failure. It serves as a marker for liver function and helps determine appropriate treatment.
In end-stage liver disease, liver functions decline to a point where the only option is transplantation. To get on the UNOS transplant list, you need a MELD score — or PELD score if you’re under age 12.